Authors Genna R Cohen 2013 License Unless otherwise

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COURSE MAP-WEEK 10 5 Lectures i 6 5 DOMAINS 10 METHODS 4 INFO. RESOURCES ON YOUR OWN ii EHRs (Vist. A) Elements & functions of Info. Systems Skill Modules time HIT STANDARDS

S N O Z I N I T A 8 6 6 F F A O N G T I H R T O N I L E O B A M RE E – E H 2 G A 4 O A C 5 T I AN LTH N S 3 O M EA – 1 I 0 T S 8 2 C C 6 H 6 U T I D A R O M R M E H B T OR N M F I E N V I O N P 6, Genna R. Cohen, HSOP grcohen@umich. edu

BACKGROUND: WHO I AM Ph. D Candidate in Health Services Organization and Policy § School of Public Health § Studying physician practices; HIT Research Analyst at the Center for Studying Health System Change § Researched physician practices; HIT; health insurance § Washington, DC 5

AGENDA: WHAT ARE WE GOING TO DO 1. Why Organizations? 2. Background about Healthcare Organizations 3. Management Issues in Healthcare Organizations 4. IT Issues and Healthcare Organizations 5. Methods of Studying Organizations 6

ARE ORGANIZATIONS IMPORTANT? “Question Box” by Raymond Bryson 7

ARE HEALTH CARE ORGANIZATIONS UNIQUE? Similarities to other human services organizations (ex: social work; advocacy; education) 1. Moral nature of work 2. Atypical relationship with clients (like students) (Martin, Lassman, Washington, Catlin, & Team, 2012), (Hasenfeld, 1992), (Burns, 8 Bradley, & Weiner, 2011).

ARE HEALTH CARE ORGANIZATIONS UNIQUE? Differences from other human services organizations: § 18% of 2010 GDP and growing – 2 nd largest industry in the US! § Unique combination of attributes: 1. Difficulty defining and measuring outcomes 2. Variable and complex work 3. Emergent and nondeferrable work 4. Little tolerance for ambiguity or error 5. Professional autonomy 6. Organizations do not always employ their members 7. Interdependencies among staff (Martin, Lassman, Washington, Catlin, & Team, 2012), (Hasenfeld, 1992), (Burns, 9 Bradley, & Weiner, 2011).

US HEALTHCARE SYSTEM Government Employer Patient Provider Insurer 10

KEY CHARACTERISTICS OF HEALTH CARE PROVIDER ORGANIZATIONS • Size • Affiliation with other organizations • Geographic location • Rural vs. Urban • Safety net status • Teaching status • Not-for-profit vs. For-profit (“investor-owned”) • Culture, leadership, payer mix 11

RELATIONSHIPS BETWEEN ORGANIZATIONS Clinic 2° Community (District) Hospital 3° Medical Center 1° Health Center Slide courtesy of Rich Lichtenstein, 2010 12

Image Removed Due to Copyright BOUKUS, ELLYN, ALWYN CASSIL AND ANN S. O’MALLEY, A SNAPSHOT OF U. S. PHYSICIANS: KEY FINDINGS FROM THE 2008 HEALTH TRACKING PHYSICIAN SURVEY, DATA BULLETIN NO. 35, CENTER FOR STUDYING HEALTH SYSTEM CHANGE, WASHINGTON, D. C. (SEPTEMBER 2009). 13

COMMUNITY HOSPITALS BY BED SIZE, 2008 51% of US hospitals are under 100 beds Source: AHA Hospital Statistics, 2009 14

HOSPITAL-PHYSICIAN TRENDS 2000 -2008 0, 4 0, 35 Employment 0, 3 0, 25 0, 2 0, 15 Open Physician-Hospital Org Independent Practice Association 0, 1 Management Service Organization CPHO Group practice without walls 0, 05 0 2001 2002 2003 2004 2005 2006 2007 2008 Source: American Hospital Association annual survey 15

AGENDA: WHAT ARE WE GOING TO DO 1. Why Organizations? 2. Background about Healthcare Organizations 3. Management Issues in Healthcare Organizations 4. IT Issues and Healthcare Organizations 5. Methods of Studying Organizations 16

MANAGEMENT ISSUES IN ORGANIZATIONS 1. Leadership and decision-making • Autocratic • People-oriented • Bureaucratic /relations-oriented • Charismatic • Servant • Democratic/ • Task-oriented participative • Transactional • Laissez-faire • Transformational 17

MANAGEMENT ISSUES IN ORGANIZATIONS 1. Leadership and decision-making 2. Culture § Competing values around • • Collaboration Competition Creation Control 18

MANAGEMENT ISSUES IN ORGANIZATIONS 1. Leadership and decision-making 2. Culture 3. Integration/Relationship with Other Organizations • Physician Organization: Multiple Practices • Physician-Hospital Organization: Hospitals + Physician Practices • Integrated Delivery System: Health Plan + Providers • ACOs 19

AGENDA: WHAT ARE WE GOING TO DO 1. Why Organizations? 2. Background about Healthcare Organizations 3. Management Issues in Healthcare Organizations 4. IT Issues and Healthcare Organizations 5. Methods of Studying Organizations 20

HEALTH CARE ORGANIZATIONS’ IT NEEDS 1. Operational (e. g. , bill paying, medical history) 2. Planning (population management) 3. Communication (handoffs) 4. Documentation and reporting (joint commission audits) 5. Ability to use IT to transform and innovate (ACOs/PCMH) 21

COMPETING IT PRIORITIES IN HCOS 1. Clinical vs. administrative needs § Who is paying? § Who is using? 2. Primary vs. secondary use 3. Current documentation care vs. future decisionmaking 4. HIPAA 22

TODAY, LET’S COMPARE… Small Large Suburban Urban Independent Primary care practice System Hospital 23

COMPARE AND CONTRAST IT ISSUES… • What are the IT priorities of these organizations? • What policy issues should they be concerned about Small Independent Suburban PCP • Who makes decisions? • How do you reach consensus? • What type of support do they have? • How does that affect the systems they buy? Vs Large Urban Hospital System 24

AGENDA: WHAT ARE WE GOING TO DO 1. Why Organizations? 2. Background about Healthcare Organizations 3. Management Issues in Healthcare Organizations 4. IT Issues and Healthcare Organizations 5. Methods of Studying Organizations 25

HOW WE STUDY ORGANIZATIONS Organization studies Organizational Theory (Macro) Organizational Behavior (Micro) 26

WHAT DO WE WANT TO KNOW ABOUT ORGANIZATIONS? ORGANIZATION THEORY ORGANIZATION BEHAVIOR • Why don’t all organizations look the same? • How do you motivate people in organizations? • Can organizations change, or must new ones replace ineffective ones? • What makes a good leader? What are the impacts of good leadership? 27

HOW DO WE ANSWER THESE QUESTIONS? 1. Surveys § Who do you survey? § More than one person per organization? § Same person multiple times? 28

HOW DO WE ANSWER THESE QUESTIONS? 1. Surveys 2. Interviews and site visits § How do you select cases? § What type of information are you recording? 29

HOW DO WE ANSWER THESE QUESTIONS? 1. Surveys 2. Interviews and site visits 3. Linking together secondary datasets § Analyzing publicly available information – CEOs, boards of directors, stockholder reports § Market share and other performance metrics § What organizations are left out of this approach? 30

K N A ! U YO TH Q U E S T IO N S ? Genna R. Cohen, HSOP grcohen@umich. edu

IMAGE ATTRIBUTIONS • • • • “Question Box” by Raymond Bryson is under a Creative Commons license CC BY 2. 0. “Pharmacy mortar and pestle 2” by J_Alves is in the Public Domain. “Wood Table” by ozerkavak is in the Public Domain. “Woman Doctor” by Gerald_G is in the Public Domain. “PC back” by yyycatch is in the Public Domain. “PC front” by yyycatch is in the Public Domain. “Doctor” by moself is in the Public Domain. “After the stroke” by moini is in the Public Domain. “Thomasville Medical Center” by Novant Health is under a Creative Commons license CC BY-SA 3. 0. “Alaska Anchorage Community Hospital 1972 01” by Piergiuliano Chesi is under a Creative Commons license CC BY 3. 0. “VSU Health Center” by Jadvii is under a Creative Commons license CC BY 3. 0. “Dzhida (Clinic) by Аркадий Зарубин is under a Creative Commons license CC BY-SA 3. 0. “Balance Scale” by Gerald_G is in the Public Domain. “Pear” by matou is in the Public Domain. “apple” by matou is in the Public Domain. 32